Laserfiche WebLink
19'880 -west well WELL/PUMP PERMIT <br />P <br />S, 4! .JOA06IN COUNTY ENVIRONMENTAL HEALTH DEPT 1868 East Hazelton Avenue - STOCKTON CA 95205.6232 - (209) 468-3420 <br />NONREFUNDABLE PERMIT CALL 209 953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br />JOB ADDRESS0 <br />1274 N �T RT $$ CITY/ZIP_T.rl- i)T gr,240 rn <br />CROSS STREET T, T V OAK RD- APN 063-1 8-025 PARCEL slzE 15 7. a2v (ISE APPLICATION # A <br />OWNER NAME JOHN BAVA M <br />Tr <br />OWNER ADDRESS 12742 E . COMSTOCKTRD / PD P�9X `J �$ TATER ��TOCKTON CA 95215 <br />CONTRACTOR Delta Prima cT!)C'KTnN ARMATi1RF & MOTO <br />R WORKS m <br />CONTRACTOR <br />646 S. California Street CITY/STATE/ZIP Stockton CA 95203 m� <br />(SUBCONTRACTOR _ <br />SUBCONTRACTOR ADDRESS <br />LICENSE O C-57 X C -G1 J D-09 0 Other <br />GEOGRAPHICAL INFORMATION: COordlnates X <br />INTEN_ p,_ Ep USE ❑ Oomestic/Private Irrigation/Agricultural G Industrial C Water Quality Monitoring 0 Soil Sampling/Characterization <br />Public Water System <br />((different from Owner. a er ys em ame <br />on a ame or one um er <br />TYPE OF WORK 0 New Weil Replacement Well C Well Alteration/Modification p Other <br />Monitoring Welt(s) # of wells L; Soi! Boring(s) # of borings <br />C Our -Of -Service Welf, u Geotechnical <br />L. Out -Of -Service Well Renewal 0 Cross -Connection Repair <br />C New PumD n Pumn Rcnl—em­ n.. <br />PHONE <br />C%TYIcu•T ATE12tP r <br />_ NUMBER 724778 EXPIRATIONDATE 08/I <br />Y Township Rancre Sectinn <br /># of borings <br />Drilling Method C Mud Rotary Air Rotary 0 Auger 0 Cable Tool D Push Point D Other <br />Proposed Well Depth ft Excavation in diameter 0 Open Bottom 0 Gravel Pack/Gravel Size in diameter <br />C Conductor Casing in diameter / Conductor Casing Depth it <br />Well Casing Diameter —in Thickness/Gauge/ASTM Sched <br />Grout Seal Depth D Steel D Plastic D Stainless Steel 0 Other <br />p ft C Neat Cement (94 /b bag/5-10 gal water <br />t3entonite (20% solids) II Other Sand Cement sack mix/7 gal water <br />Grout Placement Method 0 Pumped 11 Free Fall 0 OtherI <br />D Retardant /Accelerator (name) <br />PEDESTAL Installed By Driller G Pump Contractor 0 Other <br />Concrete Pedestal Dimensions: Width ft I P„�rr, u , <br />rump 0 SubmersibleOXIXrbine r- Other r_ <br />HP Pump Set ft Standing Water Level ft <br />I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THAT THE WORK WILL BE DONE IN ACCORDANCE WITH SAN <br />CURRENT <br />COUNTY ORDINANCES, STATE LAWS, AND RULES AND REGULATIONS. I ALSO CERTIFY THAT MY REQUIRED LICENSE IS <br />CURRENT AND ACTIVE WITH THE CALIFORNIA CONTRACTORS STATE LICENSE BOARD AND THAT 1 AM IN COMPLIANCE WITH ALL <br />WORKERS COMPENSA�� <br />Application Accepted Sy <br />Grout Inspection By <br />Pump Inspection By <br />Soil Boring Inspection By <br />COMMENTS „ I , r <br />c:otles I Info <br />EHD 43.06 <br />8/04/08 <br />HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS <br />TITLE CEO DATE 10/03/2017 <br />EPARTMENT USE ONLY <br />Date l u h -11 L <br />Area I I Employee iD# �Ln <br />Date SPECIAL Well Permit <br />Date e' e -/J WAIVER Received <br />Constructed Well Depth ft <br />E <br />hec Amount <br />S Remitted Date <br />Invoice # I Well ID# <br />WELL /PUMP PERMIT <br />